Managed care assistance when prescribing Penlac®
Managed Care Prior Authorization Requirements for onychomycosis:
- Onychomycosis (tinea unguium; ICD-9 code 110.1)
Most managed care organizations require a positive diagnosis of onychomycosis, either through KOH test or positive culture. Refills may require additional authorization.
Managed care organizations may require one or more of the following conditions as a prerequisite to reimbursement of topical prescription therapy for onychomycosis:
- Pain, decreased function or mobility, infection
- Diabetes
- Peripheral vascular disease
- Multiple digits involved
- Immunocompromised
- Concern of liver toxicity with oral antifungal agents
- Possible interactions with current medication
Because third-party reimbursement is affected by many factors, Dermik makes no representation or guarantee that you will be successful in obtaining insurance reimbursement.
As reimbursement codes may change with time, please confirm code use with managed care organization.
ICD-9 codes associated with onychomycosis
Please refer to specific insurer guidelines for individual patient coverage.
| Abnormality of gait | 781.2 |
| Cellulitis of toe | 681.10 |
| Difficulty walking | 719.77 |
| Disease (nail, unspecified) | 703.9 |
| Dystrophic nail | 703.8 |
| Onychomycosis | 110.1 |
| Pain (foot/limb) | 729.5 |
| Paronychia of finger | 681.02 |
| Paronychia of toe | 681.11 |
| Peripheral vascular disease | 443.9 |
| Tinea pedis | 110.4 |
| Tinea unguium | 110.1 |